Gut microbiota composition and functionality are involved in the pathophysiology of several intestinal andextraintestinal diseases, and are increasingly considered a modulator of local and systemic inflammation.However, the involvement of gut microbiota in diverticulosis and in diverticular disease is still poorlyinvestigated. In this review, we critically analyze the existing evidence on the fecal and mucosa-associatedmicrobiota composition and functionality across different stages of diverticular disease. We also explorethe influence of risk factors for diverticulosis on gut microbiota composition, and speculate on the possiblerelevance of these associations for the pathogenesis of diverticula. We overview the current treatments ofdiverticular disease targeting the intestinal microbiome, highlighting the current areas of uncertainty andthe need for future studies. Although no conclusive remarks on the relationship between microbiota anddiverticular disease can be made, preliminary data suggest that abdominal symptoms are associated withreduced representation of taxa with a possible anti-inflammatory effect, such as Clostridium cluster IV, andovergrowth of Enterobacteriaceae, Bifidobacteria and Akkermansia. The role of the microbiota in the earlystages of the disease is still very uncertain. Future studies should help to disentangle the role of the microbiomein the pathogenesis of diverticular disease and its progression towards more severe forms.

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